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- This is Kate Cruz at the eighth Annual Becker's,
HIT digital health RCM conference in Chicago.
I'm here with Michael Hassel.
Michael, to get us started,
can you share a bit about yourself,
your role, and your organization?
- Sure. Love to. Um, thanks for having me.
Uh, Michael Hasselbeck.
First and foremost, I'm a nurse, um, who early in my career,
kind of my claim
to fame was developing a statewide telemedicine program
before telemedicine was a cool thing
or even reimbursed in the state of New York.
Uh, continued to to move on in the innovation space
and, uh, currently serve as the Chief Digital Health officer
for the University of Rochester Health System.
- Fantastic. Thank you for that introduction.
Michael, when you think
of digital innovation in healthcare right now,
what is exciting you the most?
- Oh boy. You know, I, I, I'm probably gonna give an answer
that a lot of other folks have already given generative ai
and I am absolutely bullish about generative ai.
And, you know, one of the things that you know, is really
exciting for us is our innovation team got early access
to GPT four on a secured private Azure instance.
And we've had it now for months,
and we have been putting PHI into it
and really testing its boundaries of what it can do well
and, and where does it fall down.
And I have now come
to the conclusion it has never been easier
for health systems like mine
to develop our own point solutions to solve our problems.
My dev time on my innovation team has gone from six months
to a year to days to weeks using this technology.
So I am convinced this may be the first technology ever
in healthcare that's gonna make the lives of clinicians
and providers easier. Yeah,
- That would, that would be fantastic.
. Um, what, so you're clearly, you know,
at the forefront of this innovation,
what have been some early key learnings for you
and your organization?
- Yeah, you know, again, with the generative AI stuff, uh,
really emphasizing that it is now really easy
to build solutions.
You know, I'll give a a really good example.
You know, one problem that my health system struggles with,
which I would argue probably every health system in the
country is struggling with right now, is patient messages
and patient messages burning out.
The clinicians, especially, you know, with C-O-V-I-D
and opening up our patient portals,
our patients have never had more, you know,
seamless direct access
to our clinicians than they ever did before.
Now, the simple problem
of a patient message coming into the health system
and then saying, this message should go to a staff member.
This message should go to a nurse,
this message should go to a provider.
You think that'd be a super easy
problem that we could solve.
It's not, and my team, several years ago, actually right
before covid, we tried attacking this problem.
Um, I put about two full-time
data scientists on this problem.
I had a whole kind of cadre
of primary care docs labeling data,
and we tried building our own NLP models,
natural language processing models to triage these messages.
We first tried taking a structured approach to this problem,
and we realized we didn't have enough resources
to essentially build our own labeled
data set large enough to solve it.
We then took an unstructured approach
and just said, machine, you determine
where the patterns are in this data.
Can you group those, those messages appropriately?
And what we found out, the machine could not do it.
Upside of that was when startup companies would approach me
and my role of Chief Digital Officer
and say, Hey, I know you've got a patient messaging problem.
I have a machine learning algorithm to solve that problem.
I could say to those companies, you're full of it, ,
I know for a fact you ha do not have an,
an algorithm to solve this.
Fast forwarded generative ai, as I said, you know,
we got early access to GPT four,
and the first thing I told my team is I wanna re-attack.
That MyChart messaging problem took us two days, two days
to tune GPT four to triage those messages
with 97% reliability, 87% accuracy.
We ran it in a shadow pilot comparing it to our human nurse
that manages those message pools.
The AI outperforms the human nurse. Pretty impressive.
That's just the beginning of lots of different solutions
that now we as a health system can build ourselves,
leveraging these already massive pre-trained models.
- Well, and it, I mean, that's a fantastic example.
I'm kind of mind blown here.
Um, I can only like,
and you say it's almost a hundred percent accuracy,
but even, you know, when, if it isn't a hundred percent
accurate, I'm sure the message still gets to some, a human
that knows what to do with it.
Whether it's, you know, they can't answer the question
and just, you know, wasn't directly for them,
or they can forward it onto who it does belong to,
which still, you know,
that's not 300 messages a day in the
provider's inbox. So
- E Exactly.
Exactly. And you know, I've told my innovation team,
you know, where we're gonna focus this, this new technology,
all non-patient facing applications.
Now it has potential in patient facing applications,
but we're not there yet culturally.
Mm-Hmm, . But there's a lot, lot
of waste in healthcare on the non-patient facing side
where you still have a human in the loop.
Boy that's just low hanging fruit.
So where my priorities are, are actually now my providers,
my clinicians, my workforce, like how can
I free up their time so they can actually spend more time
with the patient doing what they went to school for,
and how do I get 'em out of work on time
so they can go spend it with their family?
Mm-Hmm, that's
where their opportunity is with this technology.
And we're, we're coming up with lots of different, uh, uh,
applications to help re remove
that burden off of my clinicians.
- That's awesome. So moving on to my next question, um,
and you've kind of touched on this a little bit already.
What are the top priorities that you are setting
for technology and like, what are the, in addition to,
you know, physician messages,
what are some other issues that you're trying to solve? So,
- It's a great question.
So, when I started my role, um,
as Chief Digital Health Officer for the health system,
you know, several years ago, you know, my first
priority was access.
So, you know, how do I leverage the technology that
my patients already have, their smartphones, their tablets,
their computers to more conveniently
and seamlessly enter into my health system.
So we spent two years building out our digital front door,
um, and we've had a lot of success there.
We then moved on to what I call digital patient engagement.
How do I create that stickiness or that glue?
Now I've made it easy for my patients
to enter into the health system.
How do I keep them engaged, engaged in my service lines?
But it just engaged in health promotion
and health pro prevention in general.
However, we've had to make a really significant pivot.
Instead of continuing
to build out those patient engagement opportunities
and solutions, I've had a really shift
over to my clinicians.
And the reason is is, you know,
we created all this access, which is fantastic.
Our patients have never been more engaged,
but I've got a physician workforce, a nursing workforce
that is on the ledge, you know, burnt out, ready to leave.
And so we're really honing in on
how do we make their lives better?
Because if I don't have a clinical workforce,
it doesn't matter what technology I introduce
to my patients, it's not gonna be successful. Yeah,
- Absolutely.
Where, and this isn't really a techno technology question,
but it could be if there's, you know, a solution
that you have in mind, but where is that balance
between patient access to their provider
and a provider still being sane ?
- Oh boy, that is a, that is a, a tough question.
And I think it's different from one clinician to another.
Um, and you know, I think technology
to date has opened up access points.
Mm-Hmm. , like on the patient facing side, lot
of success there.
So the access points are open,
the capacity on the other side is not there,
and we're not going to double our workforce overnight.
So, you know, we still need
to continue on the patient facing side of
how can we now leverage technologies in new ways
where maybe you don't need a clinician on the other side.
So maybe in the future, generative AI can just interact
with patients and maybe take a lot of the, the,
that interaction burden off of the, the, the clinician.
Maybe we will eventually get there.
And I think there's opportunities in digital therapeutics
and mobile apps
where you don't need a clinician on the other end to help
reduce some of that capacity side.
But at the same time, you know, again, really emphasizing
and honing in at that point.
I do have a workforce that went to school to do this,
that are passionate about helping others
who really wanna be able to do that well
and wanna have more of
that face-to-face clinical interaction.
And I need to make that happen
because our electronic health record
made it worse on our clinicians.
Uh, so, you know, really, again, freeing up their time,
giving them that passion back, um,
and joy back to, to delivering clinical care, to me is
by far my biggest focus and priority. Absolutely.
- That totally makes sense.
What is a piece of advice you would give
to healthcare leaders
or other people in your role regarding digital innovation?
- Diversity of thought and partnerships?
You know, my innovation team is very,
very diverse in my group.
I have a music professor,
I have an English faculty member, I have a chaplain,
partnered with engineers, partnered with data scientists,
partnered with computer scientists under the same roof
as faculty from my medical school,
dental school, and nursing school.
We're not a research shop.
Our expectation is not to get grants, published papers.
We're truly the innovation team
to support the health system.
The type of solutions that we've been able to come up
with using design thinking processes, leveraging
that diversity of thought has been really impactful.
Really, really powerful. The other thing is partnerships.
You know, I am, I'm actually really excited about the
disruptors entering into healthcare.
You know, there, there's a lot of discussion of, oh my gosh,
should we be trying to compete
with these big retailers moving in?
Oh my gosh, should we be trying to compete
with the big tech companies moving in?
I say it's the exact opposite.
There, there are things that the disruptors do really,
really well, given their experiences
and other verticals that are outside of healthcare.
So there are opportunities to learn with from them,
partner with them.
And at the same time, we have a lot of, as incumbents
as health systems, we bring a lot of knowledge.
We bring a lot to the table to help
what they're doing in healthcare that much stronger,
that much more impactful.
So I'm all about seeking outside of the box partnerships
with industry, with retail, with startups, um,
'cause I just think it's gonna make healthcare in general
better for all of us. Yeah,
- That's been a little bit of a theme that I've heard of,
you know, partnering rather than competing
and how that's just gonna make it easier, make it better,
and the way to go overall.
Um, is there a specific example that you want to share
where integration of informatics led
to improved patient outcomes
or enhanced patient provider communication?
You've already kind of given some, but any other
- ?
Yeah, you know, I've been, go actually old school,
you know, okay, I'm gonna go, I'm better.
Go back to an old technology today. Telemedicine.
Okay. Right. Yeah. Covid hits
every health system in the country.
We had to turn on telemedicine like overnight. Yep.
Some of us had experience in telemedicine, so it was easier
to make that transition.
But we went from, you know,
our outpatient volumes being 3% telemedicine prior
to C-O-V-I-D to literally within a week up to 80 90% of
what we were doing telemedicine focus.
Now, when I think of informatics
and I think of both my clinical informaticists, um,
on the physician and nursing side, we really leveraged data
from those groups to inform how we deploy telemedicine,
where we deploy telemedicine.
Um, you know, things that we did were
geocoding all of our patients knowing
where they were located, what social determinants
of health they face, you know,
was there internet connectivity out in those areas?
Um, you know,
were they only engaging in audio only telehealth versus
video only telehealth?
And some of the things that we learned from that,
that continues to form
our evolution in telehealth was in my rural communities
that my health system serves.
And we're, we're the largest health system in New York
state, outside of New York City.
So we have a massive geographic reach where you go 20 miles
outside of the city of Rochester.
It is very, very rural, you know, uh, uh,
farming communities. Um,
- I'm an Iowan . Yeah,
- Yeah.
You know, you know, and you know,
what we had learned in the state of New York, you know,
our previous government leadership has made a significant
investment in broadband.
So there was broadband out in these communities.
So it wasn't an access to having internet
to engage in telemedicine.
It was poverty that these rural communities were some
of the highest poverty communities
that, uh, we served.
And they couldn't afford internet in their homes.
So the only internet that they had access to
were the data plans on their cell phones.
And video is very data intensive.
And so our patients said, you know,
I can't use up my data plan
for a video telemedicine appointment,
but I will engage in audio
because you, I have unlimited, uh, texts
and speech for most telecommunication plans.
So what that led for us was, you know,
doing a deep dive into our data, we found
that it was actually these patients in these communities.
It was our Medicaid patients, our safety net,
our uninsured patients that had the biggest
benefits from telehealth in our community.
It was our informaticists that helped drive those insights.
So what we did with it was kind of twofold.
One, we did a very large analysis, one
of the first in the country, which we published in the New
England Journal of Medicine Catalyst about a year ago,
showing that for the Medicaid patient population,
all the myths that payers use to say,
I'm not gonna reimburse telemedicine at parody.
We busted 'em all and got that, got that out there.
So really kind of driving large policy change in the country
around continuing to pay for telemedicine.
The other thing is we're thinking outside of the box for
where can we set up essentially telemedicine
locations in the community were
that are convenient for patients.
One of the things when we talk about the disruptors
that I thought was potentially really, really transformative
was in July of 2020 $1 General comes out
and says, we're getting into healthcare.
We've hired a Chief Medical officer.
So getting back to our geocoding
of our patients at the University of Rochester, outside
of our city limits, 75% of our patients live 10 miles
or more to the closest primary care office.
And it gets even worse for our urgent care offices
looking at those same patients.
And we geocoded the Dollar Generals in our market,
85% of our patients outside
of the city limits live within two
to three miles of a Dollar General.
So you think about that, what a great opportunity to think
outside of the box
to capture patients in their own communities
where we know we have broadband, we know we have wifi,
and we could deliver telemedicine into those settings.
Now, Dr.
Wu, the CMO of Dollar General is still figuring out,
you know, what their path forward and strategy is,
but it just gives you that concept of
where there's opportunities to create new partnerships
to deliver care into these communities.
And again, informatics drove us that direction. Yeah,
- That's really interesting.
You know, hearing Dollar General, which
it's a name, we all know what it means.
And then we have the Walgreens
and the CVSs that you think kind
of have their foot in the door in healthcare.
Do you know why they aren't doing these things?
Or are they, and we just don't know about it?
- Well, they are, you know, we know, you know, CVS Health
as made significant investments into virtual care.
Telecare Walgreen with Village md, you know, have,
have done the same, you know, where there's potential
leg up for maybe a disruptor like Dollar General
or even a Walmart is just a larger brick
and mortar presence in the community than what CVS has
or what Walgreens has.
And, you know, that scale, you know,
could have a, a big impact.
But, you know, I like the direction that the,
the retail pharmacies are going.
I like that they're partnering with, um, uh, you know,
more kind of boutique virtual primary care entities to,
to deliver care.
I like that they're making significant investments in home
care and, and, and, and, and,
and home care, uh, partnerships.
So I, I'm, I'm really hopeful that, um,
the more that these new market entrants continue
to invest in healthcare, that it's going
to force incumbents like me to do things different.
Yeah. And we have to do things different. Yeah.
So I I, I think CVS and Walgreens are doing it.
I just think others may have a larger presence. Yeah. To
- That - Makes sense. Capture more patients.
- That makes sense. So we, we went on to,
we went back in the past for telemedicine way,
way back in the past, all the way
- Olden day - Back when I was a child.
Um, five years from now, looking into the future,
what do you think it's going to look like?
What are the most significant changes that there will be
and how do leaders and people in your role need to prepare?
- Yeah, so, you know, I think everything always comes,
kind of goes, comes around and comes back.
So, you know, early days of healthcare,
our clinicians went out
to patients' homes like we're in patients
homes, delivering care.
You know, weren't having to be
latched onto a computer, documenting those notes.
I actually think that that is going to be the future.
In five years from now, I think with ambient technologies,
you know, there will not be a need for
the electronic health record as we think of it today.
Those interactions between patients
and providers will be captured, you know,
using speech recognition, which we're seeing
with ambient documentation being captured
with things like computer vision and sensors
and cameras capturing those interactions, documenting.
So the clinician can again, really focus on
that empathetic hands-on care that they went to school for.
And I also think
that value-based care is going to happen.
I know we've been talking it for, for a really,
really long time, but we're at a tipping point.
Covid told us that not only will patients
and providers engage in healthcare virtually, it told us
that the traditional fee
for service reimbursement model is unsustainable.
And it told us that
healthcare in the future shouldn't be focused on
how many surgeries can I do?
How can I keep my hospital at 110% occupancy rates?
How can I keep patients coming
through the emergency department?
It's really told us that we need to focus on
how many days can I keep someone healthy,
independent living in their own home?
That's where the disruptors are making
their large investments.
That's what the big insurers are starting to shift towards.
Government pools, Medicare advantage, Medicaid managed care.
We're seeing this really rapid growth
of the pay buyer concept.
So I think healthcare five years from now will be more under
capitation, really more focused on delivering care outside
of the hospital walls out into the community.
And I think technology
and these disruptors are gonna help us get there.
So I am so excited to be in healthcare right now
'cause the future looks really, really good.
- And I can tell, I am sure our listeners can hear the
excitement in your voice.
Um, is there anything else you want our listeners to know
before we sign off today?
- Yeah, you know, I'm very proud of the University
of Rochester and the University of Rochester Medical Center.
You know, I was born and raised in, in Rochester, New York.
Um, you know, we're an innovative community home of some
of the, you know, large innovative companies
that our country has seen, like Eastman Kodak
and the birth of the digital camera
and, and digital process.
Xerox, you know, and their influence.
Xerox has had on Apple with Macintosh computers
that came outta Rochester.
And we still embrace innovation
and that ethos in our community that
although today the largest
employer in our community is not no longer a big tech
company like Kodak
or Xerox, it is the University of Rochester.
It is an academic health system.
We wanna be on the cutting edge, we wanna be innovative.
And, you know, to do that, it's gonna be a team sport
and we wanna work with others that have that same why
and essentially create this coalition of the willing
and bring people to work with us in Rochester.
And we may not, you know, do as well
as the health systems in Silicon Valley
or some of the Boston
or New York City who have better branding,
better presence than us.
But I want the world to know we are leaders in Rochester.
We wanna make healthcare better,
and we wanna do it with others.
So if there are other health systems, industry partners,
startups reach out to us.
We're always looking for new partners to, to,
to make healthcare better for this country.
- Awesome. Well, thank you so much for your time today.
It's been an absolute pleasure
speaking with you, Michael. Love
- Dictate.
Thank you. All right.
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